Continuous monitoring of endotracheal tube obstructions using naturally occurring pressure and flow oscillations

The endotracheal tube resistance dominates the total airway resistance in most intubated patients. Mucus deposition and biofilm formation can rapidly increase tube resistance and thereby contribute to serious ventilatory impairments, including dynamic hyperinflation, intrinsic PEEP build-up, added work of breathing, and patient-ventilator asynchrony. During controlled mechanical ventilation, an increased tube resistance can be inferred from the difference between peak and plateau pressure, but this approach fails during pressure-supported spontaneous breathing. Here, we present a method that estimates the linear and nonlinear components of tube resistance from naturally occurring airway pressure and flow fluctuations at the airway opening, without a tracheal pressure sensor and without applying mandatory forced oscillations. This is achieved by solving the equation of motion using band-pass filtered airway pressure and flow signals. Band-pass filtering isolates the relevant resistive and inertive pressure losses across the tube by removing slow contributions from muscle pressure and lung elastance as well as high-frequency noise. The method accurately recovers both linear and nonlinear tube resistance parameters with < 10% error and < 2% bias. Moreover, it enables real-time implementation of full Automatic Tube Compensation (ATC), even in the presence of severe tube obstructions. Continuous estimation of endotracheal tube resistance from naturally occurring airway pressure and flow fluctuations enables real-time detection of clinically relevant tube narrowing and may help improve patient safety, reduce patient-ventilator asynchrony, and facilitate weaning.